The number of Americans with end-stage renal disease (ESRD) and who require dialysis is growing rapidly. Twenty million people suffer from chronic kidney disease (CKD) in the US and are at risk for ESRD with African Americans (AA) at a much higher risk for CKD and ESRD than Caucasians (C). Cigarette smoking is a modifiable risk factor for ESRD and given the racial disparity in ESRD, it is plausible that AA may be more susceptible to renal injury from smoking than C. The study proposes to examine the associations between smoking and kidney disease and to what extent the injurious renal effects of this exposure varies by race. Existing databases will be used to examine the effect of smoking on the progression of CKD and the incidence of ESRD as it differs by race. Persons with CKD will be enrolled in a study to examine the dose dependent association between cigarette smoking and renal injury across racial groups. Focus groups will explore the awareness of the association between kidney disease and smoking and barriers to smoking cessation as they differ by race. The expected findings are that smoking has a more damaging renal effect on AA relative to C, and in this way contributes to the wide disparity in ESRD incidence rates between races.